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Error and Warnings Reusable Web Items Once you select a Web item to work with, another screen area is identified, which is Properties You can adjust the appearance of the WAD to your requirements using the options available in the context menu under View in the toolbar The Web template is handled differently from the other components such as Tools and Help Windows In the case of the other components you can show and hide the individual screen areas and toolbars using the View menu options, shown here The Web Template area is not available in this context menu and therefore Copyright by SAP AG can t be adjusted You can move the three toolbars and the Web Items and Properties screen areas as you require Depending on where you move an object to, it is anchored or floats freely as a toolbox The following illustration shows everything in a horizontal position This is not the greatest format but it does show that you can realign these GUI elements just about any way you want Because the WAD is a multiple-document interface (MDI) application, you can open and manage different windows with Web templates at the same time You can use the Window menu to arrange other windows differently: cascading (overlapping), vertically, or horizontally

Severe closed head injury is almost universally accompanied by cortical contusions and surrounding edema The mass effect of contusional swelling, if suf ciently large, is a major factor in the genesis of tissue shifts and raised intracranial pressure The CT appearance of contusion has already been described (page 751; see also Figs 35-4 and 35-5) In the rst few hours after injury, the bleeding points in the contused area may appear small and innocuous The main concern, however, is the tendency for a contused area to swell or to develop into a hematoma This may give rise to clinical deterioration hours to days after the injury, sometimes abrupt in onset and concurrent with the appearance of swelling of the damaged region on the CT scan It has been claimed, on uncertain grounds, that the swelling in the region of an acute contusion is precipitated by excessive administration of intravenous uids ( uid management is considered further on in this chapter) Craniotomy and decompression of the swollen brain is usually of little bene t

One or several intracerebral hemorrhages may be apparent immediately after head injury, or hemorrhage may be infrequently delayed in its development by several days (Spatapoplexie) The bleeding is in the subcortical white matter of one lobe of the brain

or in deeper structures, such as the basal ganglia or thalamus The injury is nearly always severe; blood vessels as well as cortical tissue are torn The clinical picture of traumatic intracerebral hemorrhage is similar to that of hypertensive brain hemorrhage (deepening coma with hemiplegia, a dilating pupil, bilateral Babinski signs, stertorous and irregular respirations) It may be manifest by an abrupt rise in blood pressure and in intracranial pressure In elderly patients, it is sometimes dif cult to determine whether a fall had been the cause or the result of an intracerebral hemorrhage Craniotomy with evacuation of the clot has given a successful result in a few cases, but the advisability of surgery is governed by several factors, including the level of consciousness, the time from the initial injury, and the associated damage (contusions, subdural and epidural bleeding) shown by imaging studies The wider application of intracranial pressure monitoring and of CT scans at intervals after the injury should facilitate diagnosis and perhaps help to elucidate the pathogenesis of delayed hemorrhages Boto and colleagues determined that basal ganglia hemorrhages were prone to enlarge in the day or two after closed head injury and that those over 25 mL in volume were fatal in 9 of 10 cases It should be mentioned again that subarachnoid blood of some degree is very common after serious head injury A problem that sometimes arises in cases that display both contusions and substantial subarachnoid blood is the possibility that a ruptured aneurysm was the initial event and that a resultant fall caused the contusions In cases where the subarachnoid blood is concentrated around one of the major vessels of the circle of Willis, an angiogram may be justi ed to exclude the latter possibility This subject is addressed in Chap 34

weighted MRI, particularly in the white matter of the corpus callosum and the temporo-occipito-parietal region This syndrome confers a high risk for slowing of development; there may be acquired microcephaly re ecting brain atrophy consequent to both contusions and infarctions A low initial Glasgow Coma Scale score, severe retinal hemorrhages, and skull fractures are associated with poor outcomes Old and recent fractures in other parts of the body should arouse suspicion of this syndrome

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